Community-Based : Male Circumcision to Prevent HIV/AIDS - Research Proposal Example

Community Based Research Proposal - Male Circumcision to Prevent HIV/AIDS Specific Aims Practically, Human Immunodeficiency Virus (HIV) is an infection, which results in causing Acquired Immunodeficiency Syndrome (AIDS). It has been evident that HIV/AIDS has been one of the rising critical health concerns worldwide throughout the 20th and the 21st century till date. This particular disease might act as a strong hindrance to the prosperity and overall social health, as it is mostly found to result in the death of the patient (Planned Parenthood Federation of America Inc.). Observably, in this similar concern, a substantial level of new infections is found to still exist particularly in the region of Sub-Saharan Africa. This eventually motivated extensive research and the subsequent introduction of numerous interventions for limiting the spread of HIV infections. In this regard, male circumcision is duly considered as one the effective interventions, which play a decisive role in the prevention of HIV infections in human bodies (Chiwele, 2011). With this concern, the goals or the objectives of the proposed research study have been determined as follows. To understand the factors contributing in HIV/AIDS To determine the reasons for treating male circumcision as one of the prime interventions of protecting HIV/AIDS To recognise the socio-cultural factors linked with the uptake of male circumcision To determine the extent to which male circumcision plays a decisive role in the prevention of HIV/AIDS Apart from the above portrayed research objectives, the hypotheses of the proposed research study are framed in the following. Hypothesis (I) – Alternative Hypothesis (H1): There is a relationship between male circumcision and the occurrence of HIV/AIDS Null Hypothesis (H0): No relationship exists between male circumcision and the prevalence of HIV/AIDS Hypothesis (II) – Alternative Hypothesis (H1): Increasing percentage of male circumcision have reduced HIV/AIDS occurrences in Sub-Saharan Africa Null Hypothesis (H0): Male circumcision has no prominent adverse effects on the occurrence of HIV/AIDS occurrence in Sub-Saharan Africa Background and Significance Understanding of the Problem According to the report published by The Learning Development Institute (n.d.), a substantial portion of new HIV infections, i.e. approximately 70% of the total registered occurrence is observed in diverse regions of Sub-Saharan Africa. From this quantitative data, it is clearly identifiable that gaining momentum of HIV/AIDS infections is progressively becoming one of the greatest challenges relating to public health, imposing upsetting impacts on the society overall. In this similar context, Gregson & et al. (n.d.) identified certain particular reasons that eventually aided in spreading HIV/AIDS infections in the regions of Sub-Saharan Africa. According to Gregson & et al. (n.d.), the reasons mainly comprised deficiency in obtaining sufficient medical facilities, poverty, insufficient education and potential barriers relating to cultural as well as social factors. As per the viewpoints of Gregson & et al. (n.d.), the potential impacts of HIV/AIDS are quite far-reaching along with being pervasive in nature, which unfavourably affects the individuals and the communities not only socially but also psychologically and financially. As noted by Tiruneh (2009), the critical concern of HIV/AIDS has become much prevalent in diverse regions of Sub-Saharan Africa. The findings propagated in Tiruneh (2009) thus revealed that a huge figure of people residing within these regions suffers from these infections, which are further accountable for the deteriorating mortality rates and social health of the community. Such chronic effects have also been linked with the shortage of education and awareness amid the community people in these regions. Justifiably, the fact that several people residing within the regions of Sub-Saharan Africa does not fully comprehend the association existing between insecure sexual practices and sexually spread diseases also reflects on the increasing percentage of HIV/AIDS in the demography (Tiruneh, 2009). Special Characteristics of the Target Population In relation to the proposed research study, the target population would be generally the men residing within the regions of Sub-Saharan Africa wherein the occurrence of HIV/AIDS is much prevalent. It will also be ensured that the selected male populaces had experiences as well as knowledge about male circumcision. With regard to determine the special characteristics of the identified target population, men aged 18 years and above, in this proposed research study will be considered. Rationale – Justification for the Study While elaborating the rationale of the proposed research study, it can be affirmed that several interventions have been introduced along with its implementation for the purpose of lessening and subsequently, eradicating the rising prevalence of HIV/AIDS. In this regard, according to Chiwele, male circumcision acted as one of the effective interventions in the context of preventing the extensive transmission form of HIV/AIDS. Thus, through this study, a scope was obtained to determine the extent to which male circumcision plays a decisive role in the prevention of HIV/AIDS. This particular intention or motivation evidently justified the rationale for conducting the proposed research study. Importance of Research Question Based on the preliminary understanding of the issue in concern in this study, the research question has been framed as following. “What are the factors that may be connected with the uptake of male circumcision among those aged 18 years or more in the regions of Sub-Saharan Africa?” According to Sahasrabuddhe & Vermund (2007), prevention along with control of Sexually Transmitted Infections (STIs) proved to remain much effective in lessening the gaining momentum of HIV infections amid the individuals residing within various regions of Sub-Saharan Africa. Based on their empirical research, Sahasrabuddhe & Vermund (2007) further noted that male circumcision, as an effective intervention procedure, had major contribution in diminishing the rising level of HIV/AIDS infections within the rural and semi-urban regions of Sub-Saharan Africa. In accordance with the standpoints of Sahasrabuddhe & Vermund (2007), male circumcision has been represented as much effective in lessening risks associated with HIV/AIDS infections and potential chances to get affected due to these diseases. Conceptually, the intervention of male circumcision in the context of diminishing and eradicating the rising infections of HIV/AIDS is fundamentally regarded as the elimination of the major proportion or the entire foreskin, which is also acknowledged as prepuce from the penis. Based on the results from various laboratory studies, the foreskin on penis is examined as much vulnerable in causing HIV/AIDS infections as compared to other penile nerves (CDC, n.d.). In this similar context, Sahasrabuddhe & Vermund (2007) affirmed that the foreskin might also possess greater vulnerability towards causing upsetting epithelial disturbances (tears) at the time of intercourse, offering a portal for pathogens’ entry, which in consequence results in HIV. While analysing the conceptual framework of male circumcision framework, Kibira et al. (2013) suggested the intervention of male circumcision as one of the effectual methods or strategies in lessening as well as eradicating the gaining momentum of HIV/AIDS infections by an extensive level. Moreover, Kibira et. al. (2013) noted that in the year 2010, an effective policy focusing on safe male circumcision had been introduced in addition with other major interventions like abstinence and condom use awareness among others for lessening the rising level of HIV/AIDS infections in humans belonging to various regions of Sub-Saharan Africa. It is worth mentioning that the HIV rates augmented in one of the regions of Sub-Saharan Africa i.e. Uganda in the year 1990 with 15 % prevalent amid the adults. However, with the process of male circumcision, the level of the same decreased to 6.5 % in the year 2010 (Shakil, 2011). Conceptual Framework In the context of analysing the conceptual framework, concerning male circumcision to inhibit HIV/AIDS, several healthcare bodies such as the World Health Organisation (WHO) suggested that male circumcision is a vital strategy for safeguarding men from being affected by HIV from their infected female partners. According to the report published by Advocates for Youth (2008), recent studies represented that circumcision delivers men extensive protection but lacks to provide complete safeguard against HIV infections through the conduct of heterosexual intercourse. As per the observations made in the report of PEPFAR (n.d.), male circumcision, as a medical intervention to HIV protection, is regarded as an elective surgical procedure based upon which, various HIV/AIDS related services along with messages are delivered to the individuals prone to such diseases or affected by the same. These messages as well as services usually comprise early HIV testing, STI treatment, awareness programs for HIV/AIDS prevention methods, wound care based on post-operative conditions and facility of using male along with female condoms. The report published by PEPFAR (n.d.) also connotes certain activities performed by various nations pertaining to the intervention program focusing on male circumcision. According to this report, the activities entail promoting clinical trainings, advancing counselling programs along with communication based approaches and conducting regular facility and community assessments. Moreover, the other activities include working with the governmental bodies of the respective nations for forming quality assurance along with medical ethical standards, developing HIV/AIDS service provisions and finally, supporting the incorporation of male circumcision related elements into supply chain management as well as surveillance systems (PEPFAR, n.d.). In accordance with the report published by PEPFAR (n.d.), secured and effectual medical services of male circumcision are offered in this present day context with the aim of lessening the rising level of new HIV infections and other forms of sexually spread diseases. As noted by Kibira et al. (2013), there exists a strong linkage between ‘circumcision status’, ‘risky sexual behaviour’, ‘age at circumcision’ and ‘HIV status’. It is worth mentioning that in developing nations, the intervention of male circumcision is fundamentally prejudiced by ethnic or cultural and religious reasons including financial and socio-demographic factors (Kibira et al., 2013). Based on the above discussion, the conceptual framework concerning male circumcision towards the prevention of HIV/AIDS can be better understood with the help of the following graphical illustration. Source: (Kibira et al., 2013) As per the above-depicted conceptual framework, the report published by Advocates for Youth (2008) suggests that the governmental bodies of the respective nations must ensure that the intervention assistance in terms of male circumcision is offered with full adherence towards the principles associated with human rights along with medical ethics. Moreover, the report of Advocates for Youth (2008) also recommends that certain vital facets, such as confidentiality, informed consent and coercion absence ought to be assured by a certain level when performing this intervention process. Research Methodology Introduction – Overview of Proposed Study According to Chiwele (2011), a considerable proportion of people, i.e. approximately 2.5 million had been newly infected with HIV/AIDS in the year 2007. During this particular year, two-third of the previously mentioned infections was traced in Sub-Saharan Africa. From these facts along with figures, it can easily be comprehend that highest prevalence of HIV/AIDS in the entire world exists in Sub-Saharan Africa. As per the observation made by Chiwele (2011), the figure depicting the overall HIV/AIDS infected population in Sub-Saharan Africa is likely to be augmenting in future in the absence of effective preventive measures. The rising level of HIV/AIDS infections in the regions of Sub-Saharan Africa has undoubtedly intensified the need for utilising effective interventions through the use of available resources. One of the interventions that have been found to remain much effective in preventing individuals from getting affected by HIV infections is male circumcision. In this similar context, Chiwele (2011) affirmed that the intervention of male circumcision is duly considered as a typical surgical procedure, which acts as an important strategy towards minimising the chances of HIV/AIDS infections getting spread. Study Design According to Volberding & et al. (2012), the intervention of male circumcision is fundamentally described as the surgical exclusion of the skin, which covers the tip of the penis. This intervention has been proven much effective in preventing men from getting infected with HIV/AIDS. Volberding & et al. (2012) also identified that this particular intervention of male circumcision is broadly adopted and utilised in Sub-Saharan Africa, due to the prevalence of higher percentage of HIV risks. Accordingly, the intervention of male circumcision has been chosen for the proposed research study as it is mainly concerned about the prevention of HIV/AIDS through the conduct of male circumcision in diverse regions of Sub-Saharan Africa. Moreover, this particular intervention has been chosen owing to the reason that the aspect of male circumcision possesses the capability to lessen heterosexual HIV transmission up to the level of 60%, which might play an imperative role in preventing HIV/AIDS in Sub-Saharan Africa region (Volberding & et al., 2012). In accordance with the report published by AVAC (n.d.), the dual treatment arms of the male circumcision intervention generally comprise offering circumcision immediately and asking men to wait for a year for surgery. As per the observation made in the report of AVAC (n.d.), the control conditions associated with male circumcision fundamentally include generating awareness regarding the use of condoms in a proper manner, following effective STI treatments and HIV testing along with risk-reduction counselling among others. The report of AVAC (n.d.) also demonstrated the site coordination of the intervention through male circumcision to be a quality heath facility, which offers certain fundamental services like surgical, diagnostic and medical assistances among others. It can therefore be affirmed that the site coordination of male circumcision is often viewed as an authorised health facility, which tends to offer effective medical services linked with diagnostic, preventive or treatment methods of a specific disease (Volberding & et al., 2012). Study Sample & Target Population Concerning the study sample and target population linked with the proposed research study, it can be affirmed that the medical professionals, healthcare regulatory bodies and the general public including males along with females would be taken into concern. Accordingly, the target population in this proposed research study would basically comprise the males belonging to the age group of 18 years and above living in Sub-Saharan Africa region. It is expected that the sample, which would be taken into concern for this proposed research study will certainly aid in delivering appropriate results. For instance, while the selected study samples shall deliver effective information in justifying the interrelationship between male circumcision and HIV prevention, the target population (i.e. males aged 18 years or above with an experience of circumcision) will assist in examining the effectiveness of the process and the consequences in brings in their social life. Sample Size The sample size for this particular research study can be ascertained as 100 adult males, out of which 50% of these are likely to respond in the primary data collection method. After acquiring a brief idea about the target population, it can be affirmed that there exists certain factors, which require considering the determination of an appropriate sample size, at both individual and group levels. In relation to the proposed research study, one of the essential factors, which require to be taken into concern in determining an appropriate sample size, is the target population to deal within the selected samples. Moreover, the other factors that might require to be considered include the site/location, wherein the sample will be conducted, design, which determines about how the sample will be conducted and results implying way to determine the outcomes. Additionally, the other vital factors required to be consider in determining a suitable sample size linked with the proposed research study encompass sampling costs, population spread and precision of the final estimations (Ryan, 2013). Sampling Strategies Theoretically, sampling strategies are regarded as the techniques of selecting appropriate and required sampling groups. Observably sample techniques often engage the researchers in selecting participants or respondents for smooth conduct of their respective research studies. There lay various sorts of sampling strategies that are often adopted and exploited by the researchers while conducting a particular research study. In this similar context, the diverse sorts of sampling strategies entail random sampling, non-random sampling and qualitative sampling as the majors (Punch, 2005). With regards to the proposed research study, which focuses upon determining the role of male circumcision in preventing HIV/AIDS, the strategy of ‘random sampling’ will be implemented. Conceptually, ‘random sampling’ techniques are primarily based upon probability theory and generally produces ‘good’ samples as ‘equal opportunity’ is provided to every participant of the target population to be represented reducing researcher bias. It can thus be affirmed that the technique of random sampling would be appropriate for the proposed research study as it brings simplicity in handling the conduct of the overall research process. Moreover, the appropriateness of this ‘random sampling’ technique in relation to the proposed research study would lay in the fact that it would aid in deriving suitable results. This is because the technique of ‘random sampling’ tends to avoid biasness and most significantly, can be utilised when dealing with huge target populaces (Salkind, 2010). Sampling Frames As discussed in the previous sections concerning sample size and target population, the respondents of the proposed research study would include medical professionals, healthcare regulatory bodies and general public including males aged 18 years and above. With regards to determine the sampling frame for this proposed research study, males aged 18 years and beyond would be taken into concern, discarding the other forms of respondents, i.e. the medical professionals and the healthcare regulatory bodies. In relation to determine sampling frame, it would be vital to mention that men belonging to 18 years and above would be taken into concern as adequate data concerning the subject matter can be acquired from them. This is because it is the men of 18 years and above belonging to Sub-Saharan Africa, who are apparently observed to suffer increased risks for HIV infections. Thus, it can be affirmed that while framing the sample size, men aged 18 years and above, will be considered, eliminating the medical professionals and the healthcare regulatory bodies. Recruitment Strategies After framing the sample size, external authorities can be recruited in order to prepare and serve the newly designed questionnaires to the participants or the respondents of the proposed research study. The questionnaires would generally comprise certain questions that are required to be answered by the respondents. The feedback of the respondents in response to the questions formulated in the questionnaires would eventually contribute to the progress of the proposed research study and most vitally, will make it complete within stipulated time frame with the successful accomplishment of the research objectives. Allocation to Treatment Arms – Description of the Process In order to describe the treatment arms of the process of male circumcision, it can be apparently observed that the process is conducted carefully through the execution of the technique of strict aseptic (sterile). Moreover, apart from this, the process is generally conducted by an experienced as well as a trained medical practitioner. It has been apparently noted that the process of treatment arms relating to male circumcision might be conducted through the use of surgical clamp techniques or through a device of special disposable plastic named as Plastibell. It is worth mentioning that male circumcision is executed as one of the vital and beneficial interventions in the prevention of HIV/AIDS in Sub-Saharan Africa due to its unique facet of proper and adequate allocation to treatment arms in an advanced manner (MedicineNet, Inc., 2014). Study Variables/Measures Based upon the conceptual framework depicted above relating to male circumcision aimed at preventing HIV/AIDS, the key dependent along with independent variables of the proposed research study can be determined. In this similar concern, the key dependent variables of the proposed research study can be apparently identified as ‘HIV status’ and ‘risky sexual behaviours’. On the other hand, the chief independent variables of the proposed research study can be noted as ‘age at circumcision’ and ‘circumcision status’. Data Collection Data Collection Methods While determining the methods of data collection for the proposed research study, it can be affirmed that a mixed approach of research methodology would be undertaken. The mixed approach would generally comprise both quantitative as well as qualitative research methods. Although a mixed research approach would be taken into concern for the proposed research study, the methods of data collection would be based upon accessing primary along with secondary data. Theoretically, primary data fundamentally refers to that particular data, which is obtained directly through the utilisation of various instruments like interviews and surveys among others. Conversely, in the case of secondary data, information is gathered with principle focus primary evidences. It is worth mentioning that primary data has been chosen as an appropriate data collection method for this study owing to the reason that it would aid in raising the validity of the research findings with due significance to both qualitative and quantitative attributes related to the issue identified. Moreover, secondary data collection procedure has also been chosen for the proposed research study as it would provide better comprehensive rationalisation to the research findings and most vitally, would advance the generalisability prospects for the study (Kothari, 2004). Data Collection Instruments One of the prime instruments, which would be taken into concern in the proposed research study, is structured interview. In this regard, a structured interview will be conducted with a pre-framed questionnaire. Specially mentioning, the interview would be conducted within 100 interviewees as in the form of respondents. These respondents would be basically the men aged 18 years and above belonging to Sub-Saharan Africa region who had experiences along with succinct knowledge regarding male circumcision. The data collected from conducting the interview can be related with primary data collection technique. On the other hand, the secondary data findings would be gathered from accessing literature based investigations. It can be affirmed from a broader understanding that the above discussed instrument would certainly support the proposed research study in becoming much responsive towards attaining the above framed research objectives. Data Management Plan In relation to a research study, Data Management Plan (DMP) is often regarded as a sort of formal document, which sketches how to manage the obtained data during the conduct and the completion of the entire project. The prime intention of DMP can be apparently observed as developing several aspects of data management that encompass data preservation and data analysis among others prior to the initiation of any project. In this regard, the notion of DMP largely ensures that all obtained data are well managed as well as arranged and made ready for preservation in future (European Commission, 2013). With respect to the proposed research study, the DMP would involve recoding of existing variables and also computing new variables. The existing variables linked with the proposed research study would thus include ‘risky sexual behaviours’, ‘HIV along with circumcision status’, ‘background characteristics’ and ‘age at circumcision’. On the other hand, the new variables associated with the proposed research study would comprise socio-demographic along with financial factors and behaviour risk compensation among others (Kibira et al., 2013). Data Analysis Overview--Goals of the Data Analysis; Special Analytic Considerations Theoretically, data analysis refers to the extraction and the compilation of raw data relating to a particular research study. In general, the goals of data analysis include predicting outcomes, supporting decisions and formulating conclusions associated with a specific research study (Carver, 2010). Based upon the proposed research study, the goals of data analysis would be focused on identifying along with interpreting the emerging theme addressing male circumcision as an effective intervention method to prevent HIV/AIDS and responding towards the categories of the background in which it took place. The special analytic considerations in relation to the proposed research study would fundamentally comprise the data obtained from accessing primary along with secondary sources. With regards to outline the analytic techniques for testing the two above depicted hypotheses, certain assumptions have been made. These assumptions have been discussed in the following. The degree of risky sexual behaviour varies between circumcised and uncircumcised males There exists a direct association between ‘risky sexual behaviour’ and ‘age at circumcision’ Circumcised males are much inclined towards HIV-negative in comparison with the uncircumcised ones Male circumcised prior to the age of 10 years are more prone towards HIV-negative as compared to those whose age falls at 10 years or above Based on the above discussion, it can be affirmed that a ‘multivariate statistical analysis’ would be conducted in the proposed research study for analysing the gathered data. Human Subjects Research The proposed research study seems to mainly deal with personal along with sensitive issues involving sex. Therefore, it can be affirmed that certain principles require to be followed for smooth conduct of the proposed research study. In this similar context, one of the ethical principles can be duly considered as delivering appropriate information to the participants of the interview about the research purpose and also the interview nature. Moreover, the other ethical principle, which requires to be adhered, would be concentrated on gaining informed consents of the respondents to participate in the interview procedure. Apart from these, in relation to the proposed research study, an assurance would be made on behalf of the participants that their privacy, anonymity as well as confidentiality are adhered to and most vitally, guaranteed to the highest possible extent. In addition, the participants would be further assured that they will be at complete freedom to accept or decline in participating into the research study. It is worth mentioning that for the purpose of adhering with the ethical principles in relation to the proposed research study and the name of the respondents would not be written in any space of the forms, assuring that their privacy along with confidentiality is preserved when interpreting the data. In this regard, the participants would also be assured about the information that they provide will not be executed in opposition to them in any manner. Thus, based on the above discussion, it can be affirmed from a broader understanding that adhering to the aforementioned ethical principles would certainly assist in completing the proposed research study quiet efficiently. Discussion Strengths and Limitations One of the major strengths of the proposed research study can be apparently stated as its scope to facilitate a broader application of community-based public health research. It can further be affirmed in this similar concern that the conduct of this particular research aided in determining the prime causes of rising risks of HIV/AIDS infections and subsequently, for planning suitable interventions for lessening the same. It is worth mentioning that this particular research focusing community-based public health research demonstrated the use of one of the vital interventions i.e. male circumcision for preventing the rising percentage of HIV infections in human bodies especially in diverse regions of Sub-Saharan Africa. As apparent, HIV/AIDS is much prevalent in this particular region owing to various reasons such as shortage of knowledge along with education and poverty among others. Through the conduct of community-based public health research, the respective governments of Sub-Saharan Africa might become much aware about the usage of male circumcision intervention in preventing risks of HIV/AIDS. On the other hand, apart from this strength, there also exist certain problems relating to the proposed research study. In this similar context, one of the potential limitations can be apparently observed as the method concerning data collection. As previously mentioned, primary data would be gathered by conducting structured interview with a pre-framed questionnaire focusing upon 15 males in the form of respondents who had experiences along with knowledge about male circumcision. With the responses of the participants if found to be quite limited, the generalisation of the proposed research study might also be hindered, obstructing the accomplishment of reliable outcomes. However, one of the probable solutions for this limitation can be making significant efforts to obtain much response from the participants with the aim of generalising the proposed research study effectively. Summary Considering its broad scope, the proposed research study will aid in gaining an in-depth knowledge about certain ways through which the prevention of HIV/AIDS can be made possible by a greater level. The importance of the study in terms of its improvement upon prior work can be determined as offering significant benefits towards public health in the form of lessening the number of rising HIV infection risks in human bodies, especially the individuals residing within diverse regions of Sub-Saharan Africa. It can therefore be affirmed that the findings of the proposed research study would be important for the governments of various nations and the individuals residing in regions accounting for high percentage of HIV/AIDS instances. In this regard, through the proposed research study, the governments of the respective nations, wherein the prevalence of HIV/AIDS is much higher, would find new ways for effective intervention focused on the aim of preventing HIV/AIDS. Similarly, the individuals having HIV/AIDS infections would be able to diminish the same through the execution of the intervention of male circumcision by a certain degree. Finally, it can be affirmed that the research findings would be informed to the individuals or the groups through discussions in groups. Other audiences of this project will likewise, be informed through data publication in authenticate social media channels as well as through peer-reviewed journal sites to be accessed by worldwide researchers and medical intervention programmers. References AVAC. (n.d.). Overview. Advocacy to Accelerate Ethical Research & Global Delivery of AIDS Vaccines and Other HIV Prevention Options, 1-7. Advocates for Youth. (2008). Male circumcision as HIV prevention. Retrieved from http://www.advocatesforyouth.org/publications/435?task=view CDC. (n.d.). Male circumcision. Retrieved from http://www.cdc.gov/hiv/pdf/prevention_research_malecircumcision.pdf Chiwele, G. (2011). Abstract. 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Retrieved from http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/hiv-aids-4264.htm PEPFAR. (n.d.). Male circumcision. Retrieved from http://www.pepfar.gov/documents/organization/107820.pdf Punch, K. F. (2005). Introduction to social research: quantitative and qualitative approaches. United States: SAGE. Ryan, T. P. (2013). Sample size determination and power. United States: John Wiley & Sons. Sahasrabuddhe, V. V., & Vermund, S. H. (2007). The future of HIV prevention: STI control and circumcision interventions. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700301/ Salkind, N. J.( 2010). Encyclopedia of research design, volume 1. United States: SAGE. Shakil, S. (2011). HIV/AIDS: how sub-Saharan Africa can win the battle. Retrieved from http://www.theinternational.org/articles/173-hivaids-how-sub-saharan-africa-can-win The Learning Development Institute. (n.d.). Problem statement. Chapter 1: Introduction, 1-10. Tiruneh, G. (2009). Determinants of adult HIV/AIDS prevalence in Africa: do cultural variations matter? Midsouth Political Science Review 10, 103-124. Volberding, P., Lange, J. M. A., Greene, W. C., & Sewankambo, N. (2012). Sandes HIV/AIDS medicine: medical management of AIDS 2012. Netherlands: Elsevier Health Sciences. Read More